So you have or are looking at that fancy wand intraoral scanner. As practices move from just using it as a tool for Invisalign and difficult patients, and into digital dentistry and orthodontics, a very common conversation is taking place between doctors and lab owners:

Doctor: “What do you mean my appliances will cost an extra $15?!?”
Lab Owner: “There is an extra cost associated with printing the scans.”
Doctor: “What do you mean it will take extra time when I am zipping you the file?!?”
Lab Owner: “There is extra time needed to process and print scans.”
Doctor: “The fancy wand salesperson told me it was going to be cheaper and faster!”
Lab Owner (as they “spice” their coffee): “Okay, let’s start from the beginning.”

I was there in a doctor’s office with the fancy wand salesperson. The salesperson had me sold on it instantly and I was nodding my head thinking of how much it could help practices and labs.

But then the salesperson started telling lies. “Appliances will be cheaper and faster to manufacture.” That’s when I started shaking my head. Violently. –I think I hurt myself.

The salesperson, along with everybody else in the room, noticed my reactionary seizure, and caught up to me afterwards. He even stopped by the lab to see what we do and how we do it. He had no clue.

Our conversation sort of started out like this:

“Short term, small picture, digital orthodontics takes more time and costs more money, which means you are setting up doctors to be pissed off at you or at me, and if they are pissed off at me, you can be certain that I’ll make damn sure they are more pissed off at you.”

Look at it from my perspective, the small lab guy. I have been pouring impressions for decades, or getting poured models directly from the doctor. The cost is minimal: plaster, a vibrator, and an employee’s few minutes. Printing a model is an entirely different animal.

Instead of a $100 vibrator, I need a $40,000 3D printer and a few thousand dollars in software, minimum. Instead of plaster that goes for $1 per pound, I need resin that costs $100-$150 per kilogram. Instead of an employee’s few minutes, the scan has to be processed through software, sent to more software and then sent to the 3D printer, set, and then printed, which can take from two to eight hours depending on the printer. And that is not even mentioning the massive investment in research and development.

When I bought my lab 12 years ago, the previous owner did not even have a computer. Now, I have four computers connected to a network and I needed to rent extra space. I can make a pretty fair guess that I have invested more money and “non-manufacturing” time (R&D) in the past two years than owners have in the past 30 years.

But then there is the big picture, the long term perspective. For that, you need to put away the coffee “spice,” break out the Red Bull, and watch a movie on YouTube called “Mindwalk.” It is not the most exciting movie to say the least, but excellently informative. It is an introduction into system’s theory–something I had to watch in college for a science writing class.

With all of the investments, all of the extra time, can digital orthodontics be cheaper and faster? Yes. But just not the way that the salesperson was explaining it.

Time is money. Chair time is an expense. Extra appointments are an expense. How much is your time worth to you? How much is your assistants’ time worth to you? –and that is where digital orthodontics and that fancy wand can make things cheaper and faster.

Excellent impressions can be about as rare as a Flyer’s Stanley Cup. How much time and money do bad impressions cost you per year? I give “nice” offices a break on the price of “dog ate my retainer” remakes, but I charge full price on awful impression remakes. I have been told time and time again that appliances made on printed scans fit perfectly with little or no chair side adjustments.

Labs have also had a huge success rate with digital debonding, allowing you to return to the old way of taking an “impression” at the last braces check and having a perfectly fitting retainer at the debond appointment, saving an entire appointment slot.

Lost or broken retainer? A simple phone call from the patient to you and then you to me has them a replacement in a week.

And then there is the branding, the prestige, of offering scans versus impressions. How much is that worth?

And all of this is just the tip of the iceberg. We are just now entering the age of digital orthodontics. I do not think we have even touched the full potential of those fancy wands. But I’m trying to keep this to a two page letter, and I think the coffee spice is beginning to kick a bit too much, so I’ll end this here but add some more information in the online version.

Cheers!

–The Lab Guy

Additional Information:

Umm, it’s not here yet.

I tried getting the intraoral scanner companies to get me information on their scanners so I could do a comparrison chart, but I have only received information from Trios.

Essentially, though, not all intraoral scanners are made equally, and not all intraoral scanner contracts are equal. You need to look at the up front costs, the annual subscription prices, and any extra costs associated with sending scans.

Sending me a scan is not instananeous. With iTero, I have seen a lapse of up to a day. With Trios, it can be instaneous.

Another question to ask is can your lab receive the scans? I am certified with 3M, iTero and Trios, which means I can. A lot of docotrs are looking at Cerec, but I can’t do anything with those scans without buying a $40,000 scanner myself as opposed to the $500 licensing fee with iTero, so it is never going to happen.

Carestream, a new player on the market? They have been as forthcoming as everybody else so I just don’t know.

The trick is I need to work with STL files, the standard in 3D modeling. Some scanner companies use a propriatry file type, like iTero and Cerec, that needs to be converted into an STL. I am pretty sure (don’t quote me) that Trios is the only true “open source” that you can export as an STL file. But it is definitely something to ask the salesperson.

To be honest, navigating through this new field is like captaining a ship in heavy seas with shoals and reefs all around. The best price is not always the best option. The best scanner might not be the best option. That clear path through the reefs ahead? It could have shallow bottom on the other side. Ask lots of questions and do a lot of research.

Good luck!

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3Shape TRIOS3 Digital Impression System
3Shape OrthoSystem

A truly open system delivered by a truly open partner

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A few doctors have mentioned to me that patients can agonize over picking a color or design for their retainers, usually while in the chair, wasting your valuable time and setting the schedule back. There is an easy fix for this:

Have an appointment card printed that includes a link to an online color chart and a space for the patient to fill in for the colors or designs they want. The link can be to our website, or we can provide you a PDF for your website. You can even contact our graphics company to redesign a color chart specifically for your practice, if you want to leave options out or add options—I would just appreciate a byline as I have been working on the thing for over 20 years. Contact me for further information.

But to the colors…

Tie Dyes and Marbles seem to be popular designs. I always plead with the assistants, and note it on the color chart, that they need to be made with colors from the specific categories. For example, Tie Dyes can be made with regular colors or tropical colors, but not one regular color and one tropical.

This is due to how the designs are created, and how retainers are made. Retainers are poured using a “salt and pepper” technique, using a liquid (monomer) and a powder (polymer). We put down a base of powder, cover it in liquid, and then repeat until we have the desired thickness.

We request colors be from a specific category because, depending on the category, they can be either a powder or a liquid. Regular colors are colored liquids that we place on clear powder; Tropicals and Neons are colored powders that we layer with clear liquid. Specialty colors are actually a combination of colored liquids and colored powders that we cannot combine into Tie Dyes and Marbles.

So if a patient asks for a Tie Dye, with, say, Cherry (regular color–liquid) and Ocean Blue (tropical color—powder), it can be tough, if not impossible, to give them what they want. Our fallback is to use a comparable powder or liquid.

For Marbles, I personally like the Regular colors. A Blueberry marbled is pictured above. I make it by using the Blueberry liquid, clear liquid, and then white powder and clear powder to give it the marbling effect.

For Tie Dyes, I like the powders, Tropicals or Neons. A special set I made for a friend is pictured above: Tropical Rainbow Marbled with Silver Glitter. I can just get them better without them running together too much.

Colors will run together creating other colors that your patient might not expect or want. This is especially true with Regular colors. Some colors, like red and black, can be over powering in Tie Dyes. I have also gotten requests for Tie Dyes where the colors are too similar (example: aqua and turquoise). A good contrast is key to a good Tie Dye.

Decals can only be placed in upper retainers. They cannot be placed in upper expanders or lower retainers: there is simply not enough room to do it properly on some so we just expanded it to all. Our selection of decals is only a sample. We can find and place anything that can be found on the internet. We are even buying a new printer specifically made for decals to produce a library of decals printed on special paper. Some of the more popular decals (sports teams and Disney characters) we cannot put on the color chart or on the web—there is that whole copyright infringement thing we want to stay away from. But if the patient requests it?

Finally, glitters. If you ask for glitter, the fallback is silver. We offer a rainbow of glitter options–including disco (the old iris or multi) and pastel rainbow glitter for that matter. All of the glitters are pre mixed with a clear powder. Many of the more popular ones are premixed with various tropical colors.

If anybody would ever like to stop by and see how retainers are made, feel free. I start pouring every evening around 5 o’clock—and I usually break out the good coffee after everybody else leaves—the fresh ground Hawaiian Kona.

-Chris (The Lab Guy)

Have you received our new color chart yet?

The logo should be the same as that on the top of this website.
Call to request as many as you need.

Click to Download Our Color Chart

An oral surgeon from around the corner called my lab the other week with an emergency, wondering if we made flippers? A patient of his, who was about to graduate college, had an unfortunate encounter between a baseball bat and his front teeth and he needed to look good for his big day. –we’ve been making flippers for over 25 years.

I can understand the oral surgeon’s lack of understanding of what we do in the lab. After 25 years in this business, my Mom still tells people that I make teeth. So, I just thought I would take a moment to clear up a few things.

Mom, I do not make teeth. That is a dental lab. I have absolutely no idea what goes into making partials, dentures, crowns and surgical guides. But we work with dental practices regularly and this is some of the typical work we get calls for:

Flippers: We can use your color guide or provide you with one of our own to make you these temporary appliances, either with the acrylic base or we can insert the pontics into clear retainers. (Up to three teeth.)

Guards and Splints: Whether you are looking for Comfort H/S Splints (we are an authorized lab—see our brochure) or a Hawley Bite Plate, or something different, we offer a wide variety of these anti-grinding appliances, usually in a week or less. Check out our “Bruxism/Grinding Appliances” page on our website.

Comfort H/S Bite Splints are 50% off for staff and their families!

Click to Learn More

Surgical Stents: Used to protect soft tissue after replacement surgery.

Fixed “Maintainers” and Tongue Cribs: Lower lingual arches, nances, trans palatal arches, tongue cribs and more to help maintain tooth position while teeth erupt or to help break bad habits.

Clear Retainers: We offer a wide selection using a variety of materials and thicknesses. Raintree Essix is our basic material for thermoformed appliances, but we are an Erkodent supplier for this superior material, whether it is the hard Erodur or the hard/soft Erkodent-Pro. Check out our website for information on Erkodent.

Sport Guards: Custom fit, superior protection.

Of course, Hawley Retainers: Our standard comes with a variety of clasping options, colors and auxiliaries for increased functionality. We now offer the Clear Bow Retainer: all of the aesthetic value of clear retainers with the durability of Hawley Retainers.

Digital Services: As a certified lab for iTero, Trios and 3M, we can accept scans directly from the scanners, though we can accept emailed STL files from any scanner. We can base the models and have them printed in resin. We can also scan your plaster or stone models to create 3D files that can be easily stored, viewed or shared using free software. Please check out website for new applications of this technology.

Alignment and realignment: You already do oral health checks as part of routine visits–why not do alignment checks? Whether your patient has had orthodontic treatment or not, teeth can shift as we get older. The earlier it is caught, the easier it is to fix. We offer short series of invisible trays and ideal spring aligners to treat minor cases and orthodontic relapse. Check out our Crystalign Work Flow on our website for more information.

As I mentioned in my previous letter, “News and Views from the 2016 AAO Convention,” the tech people grumbled about the “under usage” of their technology, not using it to their full potential. Are you under utilizing your local orthodontic lab and not realizing the full potential of your dental practice?

Thank you,

Chris Gajewski (The Lab Guy)

Ever had trouble fitting a guard or splint?
Too much grinding to make it fit?

See my new article on bite registers/wax bites from the “Bruxism” or “From the Lab Guy” pages. It’s all about carpentry.

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